Outcome of pregnancies with marginal umbilical cord insertion

Nkwabong, Elie; Njikam, Fadimatou; Kalla, Ginette Claude Mireille

doi:10.1080/14767058.2019.1628206

Cited by 26 publications

(35 citation statements)

References 14 publications

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“…We found no associati on between MCI and maternal age. Previous studies found maternal age ≥ 40 as a risk factor for MCI [4,9]. The absence of association between MCI and maternal age might be attributed to the absence of woman aged ≥ 40 in our study popu lation.…”

Section: Discussioncontrasting

confidence: 61%

“…The necessary minimum sample size was calculated as needing at least 50 cases of MCI, using the following formula: N=2×(Zα+Zβ/P0-P1) 2 ×P×(1-P), where Zα =1.96 corresponds to a type I error of 2.5%, Zβ =1.96 corresponds to a type II error of 2.5% or a power of 97.5%, P0 the prevalence of placenta abruption amongst women with MCI (29.6%) 9 , P1 the prevalence of placenta abruption amongst women without MCI (1.2%) 9 and P is (P0+P1)/2. To increase the power of our study, we decided to recruit three controls for each case.…”

Section: Methodsmentioning

confidence: 99%

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Curettage is a risk factor for marginal umbilical cord insertion

Nkwabong¹,

Mbeleck²,

Tumasang³

2020

Clin J Obstet Gynecol

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Objective: To identify the risk factors for marginal cord insertion (MCI). Material and Methods: This case-control study was carried out between 1 st February and 30 th June 2019. Singletons with and without MCI at delivery were recruited. Main variables analyzed included maternal age, parity, number of previous dilatation and curettage (D&C) or manual vacuum aspiration (MVA), time interval between each procedure and conception, cord insertion. Fisher's exact test, t-test and logistic regression were used to compare data from both groups. Results: We found 60 cases of MCI (4.1%). The signifi cant (p < 0.05) risk factors for MCI were past-history of D&C (aOR 5.97, 95% CI 1.95-18.25) particularly when conception occurred ˂ 5 months after D&C (OR 10.5, 95% CI 1.36-81.05), fetal female sex (aOR 3.82, 95% CI 1.41-10.32), parity ≥ 4 (aOR 2.63, 95% CI 1.05-12.71) and past-history of MVA (aOR 2.06, 95% CI 1.23-8.76). Conclusion: Women should be advised to conceive at least fi ve months after D&C.

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Section: Discussioncontrasting

confidence: 61%

Section: Methodsmentioning

confidence: 99%

Curettage is a risk factor for marginal umbilical cord insertion

Nkwabong¹,

Mbeleck²,

Tumasang³

2020

Clin J Obstet Gynecol

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“…155 An association of vasa previa with IVF pregnancies was also reported by Oyelese et al and Isotton et al 156,157 Marginal Insertion of the Umbilical Cord Of note, it appears that attention should also be directed at sonographic depiction of marginal umbilical cord insertion (Figures 4 and 5) in that this condition has been associated with an increase in both adverse maternal and perinatal outcomes. 106,158…”

Section: Dovepressmentioning

confidence: 99%

“…Of note, it appears that attention should also be directed at sonographic depiction of marginal umbilical cord insertion ( Figures 4 and 5 ) in that this condition has been associated with an increase in both adverse maternal and perinatal outcomes. 106 , 158 In case-controlled study in 2019 Nkwabonh et al noted a prevalence of 7.2% associated with preeclampsia (aOR = 2.94, 95% CI 1.14–7.59), placental abruption (OR = 33.68, 95% CI 9.8–115.76), nuchal cords (aOR 3.07, 95% CI 1.69–5.59), low birth weight (aOR 3.15, 95% CI 2.46–9.045) and NICU admission (OR 4.72, 95% CI 2.46–9.04). 158 …”

Section: Structural Abnormalities Of the Umbilical Cordmentioning

confidence: 99%

Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology

Sherer¹,

Al-Haddad²,

Cheng³

et al. 2021

IJWH

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The umbilical cord constitutes a continuation of the fetal cardiovascular system anatomically bridging between the placenta and the fetus. This structure, critical in human development, enables mobility of the developing fetus within the gestational sac in contrast to the placenta, which is anchored to the uterine wall. The umbilical cord is protected by unique, robust anatomical features, which include: length of the umbilical cord, Wharton's jelly, two umbilical arteries, coiling, and suspension in amniotic fluid. These features all contribute to protect and buffer this essential structure from potential detrimental twisting, shearing, torsion, and compression forces throughout gestation, and specifically during labor and delivery. The arterial components of the umbilical cord are further protected by the presence of Hyrtl's anastomosis between the two respective umbilical arteries. Abnormalities of the umbilical cord are uncommon yet include excessively long or short cords, hyper or hypocoiling, cysts, single umbilical artery, supernumerary vessels, rarely an absent umbilical cord, stricture, furcate and velamentous insertions (including vasa previa), umbilical vein and arterial thrombosis, umbilical artery aneurysm, hematomas, and tumors (including hemangioma angiomyxoma and teratoma). This commentary will address current perspectives of prenatal sonography of the umbilical cord, including structural anomalies and the potential impact of future imaging technologies.

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“…Sample size discrepancies precluded completion of the meta‐analysis 8 . Since then, several recent studies have added to the growing body of knowledge regarding the possible association between MCI and poor perinatal outcomes 12,15,16 . However, because of conflicting findings between these studies, it remains challenging to create guidelines for antepartum fetal testing and intrapartum surveillance of pregnancies with MCI.…”

Section: Discussionmentioning

confidence: 99%

Measurement of Marginal Placental Cord Insertion by Prenatal Ultrasound Was Found Not to Be Predictive of Adverse Perinatal Outcomes

Lutz

Young‐Lin

Leon-Martinez

et al. 2020

J of Ultrasound Medicine

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Objectives The clinical importance of marginal cord insertion (MCI) is currently controversial. In this study, we examined the association between MCI and adverse perinatal outcomes. We also evaluated the ultrasound‐measured distance from the site of placental cord insertion (PCI) to the placental margin (PCI distance) and perinatal outcomes. Methods This was a retrospective cohort study of MCI and control pregnancies presenting to a single institution between September 2014 and August 2016. Marginal cord insertion was diagnosed on routine anatomy ultrasound scans at 20 weeks’ gestation. The primary outcome was fetal intolerance to labor. Secondary outcomes of interest included mode of delivery, gestational age at delivery, Apgar scores at 1 and 5 minutes, birth weight, delivery complications, and neonatal intensive care unit admission. The PCI distance was determined by an ultrasound review. Statistical significance was evaluated by a χ2 analysis, descriptive statistics, Wilcoxon tests, and regression models with log‐transformed outcomes, the PCI distance, or both as needed. Results Of 675 abnormal cord insertion cases, we identified 183 that met inclusion criteria. We found no statistically significant association between MCI and fetal intolerance to labor (odds ratio, 1.24 [95% confidence interval, 0.55–2.80]; P = .71) or secondary outcomes. Furthermore, we found no significant correlation between perinatal outcomes and the PCI distance. Conclusions Our study suggests that MCI pregnancies, regardless of the specific PCI distance, might not be at increased risk of adverse perinatal outcomes. This finding questions the need for heightened antepartum surveillance of this patient population.

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Outcome of pregnancies with marginal umbilical cord insertion

Cited by 26 publications

References 14 publications

Curettage is a risk factor for marginal umbilical cord insertion

Curettage is a risk factor for marginal umbilical cord insertion

Current Perspectives of Prenatal Sonography of Umbilical Cord Morphology

Measurement of Marginal Placental Cord Insertion by Prenatal Ultrasound Was Found Not to Be Predictive of Adverse Perinatal Outcomes

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